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FOR OFFICE USE r 1 - APPLIdATf0f4 FOR SANITATION PERMIT Permit No. ----_. - t�-� �-_- �'}_-_ /3 ._- (Complete in Duplicate) Date Issued lf_�_- -___----__.--- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with C�o/unty Ordinance No. 549. JOB ADDRESS AND LOCATION--- ` ---- ----------------------------------------------------------- --------_------------------ Owner's Name______________ y} �,--- ---- - --- ��------------------- ------------------------- Phone��.��.'�CJ'.-�- -------- Address _ _- ------------ ___ - Contractor's Name._ � Phone Installation will serve: Residence Z""Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----1- Number of bedrooms Number of baths t_.2 Lot size ------ � ------------------------------ Water Supply: Public system Cr_c�ommunity system ❑ Private ❑ Depth to Water Table4 ft. (- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Say Loam ElClay Loam ❑ Clay F] Adobe[9—Mrdpan F]Previous Application Made: (If yes,date--------------------) No [K New Construction: Yes 0'-'No ❑ FHA/VA: Yes ❑ No �- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within 200 feet.) Septic Tank: Distance from nearest ---Distance from foundation---A�----------Matefial____ ____ __ ______ ___________________ No. of compartments-_-_ ._--�_ .____Size__ `i. `5 ._._,___Liquid dept----- ___ __.__--_-__-__--_Capacity---A20.0... �__ Disposal Feld: Distance from nearest well._'�'✓7:�1-._Distance from foundation-----14---------Distance to nearest lot lipe._J......... Number of lines-_.-____+-�___�__`______________Length of each line-60-7-1$71 e dth of trench-------.2:--------_-________--_-_ Type of filter materiaL ykz7�-&Depth of filter material-----`e`----__--Total length------4:V0---------------------- Seepage Pit: Distance-to nearest well----------------------Distance from foundation___________________.Distance to nearest lot line__.__-_._-___.__ ❑ Number of pits----------.-----------Lining material-------------. --------Size: Diameter------------------- Depth--------------------------------- S Cesspool: Distance from nearest well---------------------Distance from foundation--------------------Lining material_--_-______________________________. ❑ Size: Diameter--------------------------- ---------Depth--------------------------- ------------------Liquid Capacity---------------------------gals. >� Privy: Distance from nearest well -__.-----------------------------------._...__Distance from nearest building----________________________-.-___.__. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------- ----------- / P (describe): -- - ) -- -----------------------------------•--------------------------•------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing describe ------- ----- - -------------- -----------------•-----------------------•----------------- -------------•---------- -----------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------- -------------- G ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------ H I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Allw 4�� (Signed)-- `4� ''�- -------------------------------------------------------------------------------------Owner and/or Contractor) By:-------------------------------------------------------------- ---------------------------------------------------------------------(Title)--------------------------- --------------- -- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --------------------------------------- DATE---- M!— -- =- ------------------- REVIEWEDBY----------------------------------------------------- ----------------------------------------- ------------------ DATE---------- ------------------------------------------------- BUILDING PERMIT ISSUED-------------- ------------------- ------------- --- - W---- ---,�-- .-� DATE.-- -------------/ --E------------ - Alterations and/or recommendations:._ 'lr ___ . ._. I-e"_ 11?-e� 11 _ � -- -------- ---- --- .� -AL--- --------- ------ ---- !�.*a.� `---------d;zl --------------- ---------- - ------- - ---------- 3 _cam , --- --- -- --- ---- ------- -7 ------ FINAL INSPECTION BY:.----- ---- y Date- _- - ' +tom ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.